目的：分析总胆红素水平(total bilirubin level，TBIL)是否为冠心病的保护性因素及其预测价值，同时通过分析TBIL与超敏C反应蛋白(hs-CRP)的相关关系，探讨其冠心病保护机制。方法：连续选取2014年10月至2016年10月安徽医科大学第二附属医院心血管内科住院疑诊冠心病心绞痛并接受冠状动脉造影检查，且临床资料完整的180例患者作为研究对象，根据造影结果分为冠心病组(n=90)与非冠心病组(n=90)，采用logistic回归分析探讨TBIL与冠心病的相关性；双变量Pearson法分析TBIL与hs-CRP的关系；通过绘制受试者工作曲线(receiver operating characteristic curve，ROC)，探讨TBIL对冠心病的诊断价值。结果：与非冠心病组相比，冠心病组TBIL水平较低，差异有统计学意义(P<0.05)；二元logistic回归分析显示TBIL为冠心病的独立保护性因素(95%CI 0.738~0.922，P=0.001)；Pearson双变量分析显示TBIL与hs-CRP呈负相关(r=–0.367，P<0.001)；ROC曲线显示TBil正确预测冠心病的界点值为10.35 μmol/L，最大ROC曲线下面积0.739(95%CI 0.668~0.811，P<0.01)，对应的敏感度为0.633，特异度为0.700。结论：TBIL可能为冠心病的独立保护性因素，低水平TBIL可以作为冠心病的预测因素；TBIL与hs-CRP的负相关关系提示其抗炎作用可能是其对冠心病的保护机制之一；TBIL <10.35 μmol/L可以为作为诊断冠心病的界定指标。
Correlation of bilirubin with coronary heart disease and inflammatory marker hs-CRP
Objective: To investigate whether the total bilirubin level (TBIL) is the protective factor of coronary heart disease and its predictive value, and to analyze the possible relationship with hs-CRP and the possible protective mechanism of coronary heart disease. Methods: A total of 180 patients suspected with coronary heart disease who underwent coronary angiography (CAG) and complete clinical data were consecutively enrolled in this study and retrospectively analyzed, from October 2010 to October 2016. According to the results of CAG, the patients were divided into a coronary heart disease group (n=90) and a non-coronary heart disease group (n=90). The correlation between TBIL and coronary heart disease was analyzed by logistic regression analysis. The relationship between TBIL and hs-CRP was analyzed by dual-variant Pearson method. The value of TBIL in the diagnosis of coronary heart disease was investigated by drawing the receiver operating characteristic curve. Results: Compared with non-coronary heart disease group, TBIL level in coronary heart disease group was lower (P<0.05). Binary logistic regression analysis showed that TBIL was an independent protective factor for coronary heart disease; dual-variant Pearson analysis showed that there was a negative correlation between TBIL and hs-CRP; according to the ROC curve, the boundary value of TBIL for diagnosis of coronary heart disease was 10.35 umol/L, and the maximum area under the ROC curve was 0.739 (P<0.01, 95% CI 0.668 to 0.811), the corresponding sensitivity was 0.633, the specificity was 0.700. Conclusion: TBIL may be an independent protective factor for coronary heart disease. Low level TBil can be used as a predictor of coronary heart disease. TBIL has a significant negative correlation with hs-CRP, which suggests that its anti-inflammatory effect may be one of the protective mechanisms of coronary heart disease. TBIL <10.35 μmol/L can be used as a definite indicator for the diagnosis of coronary heart disease.